Chapter 5: Rehabilitation and Recovery

Chapter 5: Rehabilitation and RecoveryThe Goal of Rehabilitation

The brain heals more slowly than many other parts of the body. Recovery from a stroke is different for each person. It can often take months or years to recover.

Your goal is to be as independent as you can. You may learn new skills, improve your physical condition and learn how to do tasks in different ways.

Because a person with a stroke has specific needs, recovery will be different for each person. The recovery often includes medical care, natural recovery, rehabilitation and the gradual return to your everyday activities.

It is important to follow your health care provider’s instructions about recovery.

Rehabilitation usually starts in the hospital. You may continue with it after your hospital stay. Together, you and members of your health care team and care circle will make rehabilitation choices before you leave the hospital.

Rehabilitation Program

Your program may include:

learning about your stroke

learning ways to help you safely eat, brush your teeth, get dressed, bathe, do housework and go to the bathroom

strengthening exercises for arms and legs

receiving emotional support

testing and treatment for problems with:

— vision

— swallowing and eating

— communication

— reading and writing

— memory, attention span and problem-solving skills

49allinahealth.org/stroke

https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/understanding-stroke

learning how to:

— take medicines

— regain bowel and bladder control

— get in and out of a chair, bed or car

— position yourself in bed or chair

— get around your home and community

— enjoy your favorite leisure activities.

Planning for Care After Your Hospital Stay

Making plans for when you leave the hospital is an important part of your recovery. Your health care team will work with you and members of your care circle to plan for your discharge. This planning begins early during your hospital stay.

Depending on your needs, your plan for discharge may include rehabilitation after your hospital stay. There are different types available.

The type of rehabilitation you will need depends on:

your ability to take part in therapy

your medical and nursing needs

your care circle

the resources available in your community.

Possible options for after your hospital stay are listed on page 51. A social worker or other member of your health care team will talk with you while you are in the hospital to help decide which option is right for you.

50 allinahealth.org/stroke


Rehabilitation Options

Not everyone needs rehabilitation after a hospital stay. If you do, you have options. The type of rehabilitation you receive depends on your ability to take part in therapy, your medical and nursing needs, and your caregiver.

� Hospital programs These are for people who need doctor and nurse care every day. These programs are done in special rehabilitation hospitals or in ”acute care” hospitals. You will stay in the hospital where you have therapy. The length of time you stay in a hospital program depends on your needs and goals.

� Skilled nursing facility This care is for people who need 24-hour care. You will receive short-term or long-term care for your health needs. Your stay will depend on your needs.

� Transitional care unit (TCU) This care is for people who need more help and health care services every day than what they can get at home. Most people stay in a TCU for 2 to 4 weeks. Your stay will depend on your needs.

� Outpatient programs These are for people who live at home. They go to the hospital for care during the day.

� Home care These programs let people receive services in their own homes.

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Tip

You may not need rehabilitation after your hospital stay. Talk with your social worker about your options.

allinahealth.org/stroke


Role of Your Care Circle

Members of your care circle are important to your recovery. They need to understand what you are going through and how the stroke has affected you.

The adjustment may be easier if your care circle knows how to handle problems that may come up after you leave the hospital. Your care circle can also help by giving you support and encouragement.

Members of your care circle can help by:

taking care of themselves (eating well, getting rest, doing things they enjoy, and dealing with their own feelings such as anger, anxiety or resentment)

knowing that your progress may be slow

visiting and talking with you

sitting with you in silence

letting you know you are still needed and important

supporting your rehabilitation decisions

becoming educated about your condition and recovery

asking to go along to therapy sessions

supporting and encouraging you to meet your milestones during your recovery

showing confidence in your improvement

working with members of your health care team to create a healing environment at home

sharing responsibilities

being realistic in knowing you may have recovery limits.

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Tip

See Chapter 7 for information just for members of the care circle.



Tips for Reducing Stress During Your Recovery

Take your recovery one day at a time. Be hopeful for a successful recovery.

Create a regular routine or write lists of what needs to be done to help plan and organize your day.

Appreciate each small gain. Your emotions and ability to do things may vary from day-to-day because of fatigue. You may need to learn how to do things in different ways or try new ways of doing tasks, talking, speaking and organizing your social life.

Expect that members of your care circle will improve their skills and knowledge. They are learning right along with you.

Plan for breaks so you and members of your care circle are not together all the time. Time apart is important for both you and these individuals. Try to do activities that get you both out of the house.

Ask family members and friends to help.

Try relaxation, massage or meditation to cope with your stress.

Join a support group.

Be patient with and kind to others. You may feel irritated or upset some times, but do not blame anyone. Do not take your frustrations out on others. Talk with a family member, friend, professional or support group about your feelings.



Progressive Muscle Relaxation

Progressive muscle relaxation is a short and easy exercise to help you relax and relieve some of your pain.

Getting startedFind a relaxing position. You may sit down or lie on your back in bed. Be sure your legs and hands are not crossed.

You may close your eyes. If you prefer, you can keep your eyes open, but focus on one spot in front of you.

Bring your attention to your breathing. Think about where your breath comes in and out of your nose or mouth. Think about how your chest moves up and down with each breath.

Imagine a gentle, safe wave of relaxation that will slowly and warmly flow through your body. The wave can help you find those places that need to relax and give them permission to relax.

You can also imagine this wave in any way you find most comfortable. You may see it as light, water or just a feeling.

If your mind wanders, gently bring it back to your breathing.



Relax from your head to your feet Bring your attention to the top of your head and begin to imagine a wave.

With your next breath out, feel the wave flow through your head. Feel your jaw soften and relax.

Breathe in.

With your next breath out, focus on the back of your neck. Let it soften and relax.

Breathe in.

With your next breath out, imagine the wave moving through each arm all the way to your hands. Feel your hands become slightly heavier where they are lying.

Breathe in.

With your next breath out, imagine the wave of relaxation roll gently and safely down your spine. Let all of your back muscles relax and soften.

Continue to breathe. Feel the wave flow as you breathe out.

Let the wave flow through your pelvic area and hips into your upper legs and thighs.

Breathe in.

With your next breath out, allow the wave to find those areas in your legs and knees that need to relax. Give them permission to relax.

Breathe in.

With your next breath out, feel the wave move into your calves, then your feet. Feel your feet become a little heavier.

Take two deep breaths. Imagine any remaining stress gently flowing out the bottoms of your feet.

Take a moment to observe the still place you created. With practice, relaxation will become easier.



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Nutrition

Good nutrition is essential for your recovery. Eating well-balanced meals and snacks will help you recover quickly and help you feel your best. What you eat after your brain injury affects your well-being.

If you do not eat enough of the right foods, you will become tired and less able to take care of yourself. Be sure you make time to eat — even if you do not feel hungry.

When you are planning your meals and snacks, try to think about what your plate should look like.

Tip

According to the United States Department of Agriculture, you should:

eat smaller portion sizes

make half of your grains whole

make half of your plate vegetables and fruits

drink fat-free or low-fat milk

eat lean proteins.

Visit choosemyplate.gov for more information about nutrition.

Important

If you have questions about your nutrition and recovery, ask your health care provider.

For snacks:

protein

nonstarchy vegetables

fruit

grain

nonstarchy vegetables

protein

starch

For meals: (9-inch plate)

fruit

Tip

It is important you get enough water every day. Drink when you feel thirsty and with your meals.

Ask your health care provider how much water you need every day. Follow any special directions if you have fluid restrictions or if you have had weight loss surgery.



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Here are some examples of well-balanced meals and a snack.

At breakfast: At lunch:

At dinner: For a snack:

Nutrients important for your recoveryEating foods rich in the following nutrients are important for your recovery.

Protein: Protein helps repair and build healthy tissue.

Iron: Iron works in each of your body’s cells to help make energy.

Vitamin C: Vitamin C helps your body repair damaged tissues, keeps your bones and teeth strong, and helps your body absorb iron.

Calcium: Calcium helps build and maintain your bones, your muscles move, your blood clot, and your nerves send messages.

Fiber: Fiber helps your body produce regular bowel movements.

Use the chart on the next page to help you choose foods for building well-balanced meals and snacks.

Tip

Eat foods high in vitamin C to help absorb the iron that comes from plants such as spinach.

For instance, drink a glass of orange juice with an iron-fortified cereal.

Good sources of vitamin C are oranges, broccoli, tomatoes, kiwi, strawberries, peppers, potatoes and cabbage.



Your Exercise Program

Why exercise is importantGetting regular exercise will help:

prevent another stroke, if you had one

maintain a healthy weight

reduce the risk for heart disease, diabetes, obesity, certain cancers and joint conditions

reduce levels of anxiety and stress

improve your self-esteem and confidence

improve concentration and memory

maintain good blood pressure and cholesterol levels

give you an overall feeling of well-being

build endurance and increase your metabolism

you relax and sleep better

provide healthy blood flow to your brain

improve your mood

improve your thinking and memory

improve your walking ability

treat your pain.

Your goals Your general goal is 30 minutes of exercise at least 3 to 5 days each week. Aerobic exercise uses large muscle groups and raises your heart rate (like biking, walking and swimming).

During aerobic exercise you should be able to talk (singing would be hard).

— Your rate of perceived exertion (how hard you are working) should be between light and somewhat hard (at left).

How you can exercise Follow your exercise prescription from your therapist or doctor:

� aerobic exercise

� strength training

� flexibility and balance.

If you do not have an exercise prescription or you are having a hard time starting one, ask your doctor for a referral to physical therapy.

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Borg-RPE-skalan®

© Gunnar Borg, 1970, 1985, 1994, 1998

6 7 8 9

10 11 12 13 14 15 16 17 18 19 20

No exertion at all Very light Light Somewhat hard Hard (heavy) Very hard Extremely hard Maximal exertion

Extremely light

The scale with correct instructions can be obtained from Borg Perception, see the home page: www.borgperception.se/index.html.

Borg-RPE-skalan® © Gunnar Borg, 1970, 1985, 1994, 1998



Do what you can based on your abilities.

Walk around your house.

Walk around your neighborhood.

Do something you enjoy. Walk with a friend or with a walking group.

Join a fitness center (if you are able).

Start small.

— Exercise for 5 minutes 5 times a day.

— Add 1 to 3 minutes each day as you are able.

Signs you are doing too muchAs you exercise you should be aware of your body’s response. Signs you are doing too much include:

feeling dizzy or lightheaded

nausea (upset stomach) and vomiting (throwing up)

cold sweat

being short of breath (unable to have a conversation)

exhaustion or unusual fatigue (very tired)

feeling as if your heart is suddenly racing or pounding

any chest pain or pressure in your teeth, arm, jaw, ear, neck or between your shoulder blades.

Call your doctor if the symptoms do not go away after resting. Call 911 if you cannot reach your doctor. Do not drive yourself to a clinic or Emergency Department.



Tobacco Use is Dangerous

Tobacco products include cigarettes, electronic nicotine delivery systems (ENDS, includes e-cigarettes and JUUL®), smokeless tobacco (dip or chew), cigars, hookahs and pipes.

Tobacco use is especially dangerous to your blood vessels and arteries. It can cause atherosclerosis, a build-up of plaque (fatty substances found in your blood). Over time, the plaque hardens and narrows your blood vessels and arteries.

Smoking also makes the blood vessels and arteries sticky. This leads to “obstructions” in blood flow, meaning that your blood cannot flow easily. The side effects of using tobacco can result in needing stents, coronary artery bypass surgery or both to keep your blood vessels and arteries open. It can also lead to stroke or heart attack.

Tobacco use:

causes stroke and heart disease

increases your heart rate

increases your blood pressure

lowers your good (HDL) cholesterol

makes your heart work harder (adding stress to scarred or weakened blood vessels and arteries)

can interfere with how well your heart medicines work.

Smoking even 1 cigarette a day:

causes your heart rate and blood pressure to increase, and your major blood vessels to become smaller, causing your heart to work harder

causes your blood to clot faster; tobacco users have a higher chance of stroke and heart attack

reduces the amount of oxygen in your bloodstream, making you short of breath

slows your ability to heal.

Cigarette smoke contains more than 7,000 chemicals. More than 70 can cause cancer. The human body was not designed to smoke.

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Did You Know

Smoking doubles your risk for stroke.

(Source: Illinois Department of Health)

Did You Know

Smoking causes nearly 1 out of every 3 deaths from heart disease and stroke.

Heart disease and stroke cause 1 out of 3 women’s deaths.

Source: Centers for Disease Control and Prevention



Secondhand smokeSecondhand smoke is a mixture of smoke coming from the burning tips of cigarettes, pipes and cigars and smoke exhaled by smokers.

Anyone around secondhand smoke breathes in the chemicals from the tobacco smoke. Secondhand smoke causes death and disease in people who do not smoke.

Even briefly breathing secondhand smoke can damage the lining of blood vessels and cause your blood to become stickier. These changes can cause a deadly heart attack.

No amount of secondhand smoke is safe. According to the Centers for Disease Control and Prevention, secondhand smoke exposure causes more than 8,000 deaths from strokes.

Smokeless tobaccoSmokeless tobacco products (snuff, chewing tobacco, snus and tobacco products that dissolve) are not a safe alternative to smoking. Any form of tobacco contains many toxic chemicals and high levels of nicotine.

For example, the nicotine levels in 1 tin of smokeless tobacco is roughly equal to 4 packs of cigarettes. These chemicals move from your mouth to all parts of your body through your bloodstream. It affects your heart by increasing your heart rate and blood pressure. This can lead to a stroke.

Smokeless tobacco also contains a lot of sugar. This can make it harder to control your glucose levels.

E-cigarettesElectronic cigarettes (e-cigarettes or e-cigs), JUUL®, hookah pens, vapes, vaporizers, vape pens, e-hookah, e-pens, e-pipes, e-cigars and disposables are all known as electronic nicotine delivery system (ENDS).

E-cigarettes have become very popular very quickly. This means there has not been time to get results from long-term studies on the safety or health effects of e-cigarettes.

A 2018 public health research report supported by the FDA confirms that using ENDS products is harmful. Use causes health and safety problems and greatly increases tobacco addiction among adolescents.

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Did You Know

The risk of dying from major tobacco-related diseases is higher among former cigarette smokers who switched to spit tobacco after they stopped smoking than among those who quit using all tobacco.

Source: Illinois Department of Health

Secondhand Vape

Dangerous and harmful chemicals have been found in secondhand vape.



The name of the report is “Public Health Consequences of E-cigarettes” by the National Academies of Science, Engineering, Medicine (NASEM).”

The FDA has not approved e-cigarettes as a way to quit smoking. According to the 2018 NASEM report, there is “limited” evidence that e-cigarettes help some people to quit smoking. Many people return to smoking, continue to use the e-cigarette, or use both. None of these options is healthful.

Benefits Of Quitting Tobacco

Within... 8 hours: The carbon monoxide level in your blood drops to normal and the oxygen level in your blood increases to normal. Your breathing starts to improve.

24 hours: Your chance of a heart attack decreases.

48 hours: Nerve endings start to grow again. Your senses of smell and taste improve.

2 weeks: Your circulation improves and your lung function increases.

1 to 9 months: Your cough, stuffy nose and shortness of breath decrease. Your energy level increases.

1 year: Your chance of heart disease is cut in half.

4 to 5 years: Your chance of a stroke is the same as someone who does not use tobacco. Your chance of dying from lung cancer is cut in half.

5 to 10 years: Pre-cancerous cells are replaced with normal cells.

10 years: Your risk of cancer, stroke, and heart disease is close to the same of someone who has never used tobacco.

(Source: World Health Organization)

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Did You Know?

In 1 year of quitting smoking, your risk of heart disease is reduced by more than half. Quitting also reduces the risk of a second heart attack if you’ve already had one.

(Source: National Institutes of Health)



Behavioral Tips and Coping Skills for Quitting Tobacco

Getting started Make a list of reasons for quitting.

Think positively.

— Believe you can.

— Remind yourself, “I’m choosing not to smoke today.”

— Remember that it’s “not that I can’t smoke, it’s that I’m choosing not to.”

— Tell yourself often: “I can do this.”

— Visualize yourself as someone who doesn’t use tobacco.

Use relaxation breathing.

— Inhale to count of eight.

— Hold to count of four.

— Exhale to count of eight.

Substitute items for cigarettes.

— Chew gum.

— Suck on hard candy.

— Chew on straws or toothpicks.

— Eat low-calorie snacks.

Keep your hands busy.

— Play cards.

— Read books.

— Put together puzzles.

— Play with rubber binders.

— Make crafts.

— Write letters.

— Draw.

— Paint.

Concentrate on the good things in your life!



Change your environment:

— Change your routine to help avoid temptation. Even small changes can lower the craving to smoke.

— Get rid of all cigarettes, ashtrays and lighters in your home, car, desk or office.

— Change your favorite smoking areas to make them remind you less of smoking.

— Make your home and vehicles smoke free.

Get support from others:

— Talk to your family, friends or coworkers about how to support you while you quit.

— See if others you know would like to quit with you. This way you can support each other through the tougher times of quitting.

Plan your reward for each day you do not smoke. Think about small, pleasurable activities you can do during your day that give you joy. Long-term rewards are helpful as well, but the small rewards are just as important.

Remember that even the most intense craving lasts only 5 to 10 minutes. Wait it out. Tell yourself, “This too shall pass.”

Avoiding a relapse Think about what you are gaining from quitting tobacco, instead of focusing on what you’ve given up. For example, “It’s easier to play with my kids or grandkids.”

Have a plan for how you will deal with unexpected urges. (Take a walk, make a call.)

Think your way through difficult situations ahead of time whenever you can.

Think about past quitting attempts and what was helpful to you. Reuse them again if possible or try something new.

Explore ways to move your body with safe and realistic expectations. Increasing your physical activity can help you manage weight gain and work through emotions that otherwise would make you want to smoke.

Avoid foods high in calories and fat. Sugar can increase cravings to smoke. Limit large amounts of sugar.



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Drink lots of water. Ice water may be helpful in getting rid of a craving.

Reward yourself when you reach milestones: 1 day, 1 week, 2 weeks, 1 month, etc.

Go to places where you cannot smoke — stay away from the places you used to smoke.

Think about the money you saved!

Think of quitting as an act of love — for those you care about and for yourself!

Resources for Quitting Tobacco

Allina Health Tobacco Intervention Program at Abbott Northwestern Hospital

— 612-863-1648

Tobacco Intervention Program at Mercy Hospital

— 763-236-8008

Tobacco Intervention Program at River Falls Area Hospital

— 715-307-6075

*United Hospital Lung and Sleep Clinic Tobacco Cessation Program

— 651-726-6200

*Penny George™ Institute for Health and Healing (LiveWell Center) tobacco intervention coaching

— 612-863-5178

*There may be a cost to you. Check with your insurance provider.



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Other Quit Partner

— 1-800-QUIT-NOW (1-800-784-8669) or quitpartnermn.com

Minnesota Department of Health

— health.state.mn.us/quit

online tobacco cessation support

— smokefree.gov

American Lung Association/Tobacco Quit Line

— 651-227-8014 or 1-800-586-4872

Chantix® GetQuit Support plan

— 1-877-CHANTIX (1-877-242-6849) or get-quit.com

financial aid for Chantix® or Nicotrol® inhaler

— 1-866-706-2400 or pfizerrxpathways.com

*Mayo Clinic Nicotine Dependence Center’s Residential Treatment Program

— 1-800-344-5984 or 1-507-266-1930

Plant Extracts aromatherapy

— 1-877-999-4236

*There may be a cost to you. Check with your insurance provider.



Documents

Chapter 5: Rehabilitation and Recovery